Question 1

Who can file a workers' compensation claim?

Accepted Answer

Workers' compensation acts around the country are administered by a governmental agency for that jurisdiction. If an employee is injured on the job, he or she must report that injury to his or her employer within a designated period of time and file a written report of that injury. If the employee is forced to lose time from work or requires medical treatment, then he or she may file a claim with the administrative agency that administers workers compensation claims for that jurisdiction. Once a claim is filed, the employer can either contest or accept the claim. If the employer accepts the claim, then the employer is agree­ing that the employee was injured on the job, that the injury arose out of the employment, and that the employee is entitled to medical coverage and perhaps to wage benefits for the time disabled. If the employer decides to challenge the claim, there will be a hearing before an administrative law judge or a hearing officer who will then make a decision whether the claim is compensable and whether the employee should be paid wage benefits and/or medical benefits. There has been a good bit of litigation over the years as to exactly what constitutes being an employee. Typically a person who is an independent contractor will not qualify as an employee under the workers' compensation act. Likewise, the individual who is the owner of the business may not qualify as an employee unless he or she has expressly chosen to include him-or herself in that definition within the policy of insurance issued.

Question 2

What are the dfferent workers' compensation benefits you can get?

Accepted Answer

If you are injured on the job or suffer a work-related illness or disease that prevents you from working you may be eligible to receive benefits from your state workers' compensation program. You also may be entitled to medical care. If your disability is classified as permanent or results in death, additional benefits may be available to you and/or your family. If you receive workers' compensation benefits, however, you lose your right to sue your employer for the injury. The workers' compensation system is designed to provide benefits to injured workers, even if an injury is caused by the employer's or employee's carelessness. But there are some limits. Usually, injuries caused by an employee's intoxication or use of illegal drugs are not covered by workers' compensation. Coverage may also be denied for: self-inflicted injuries (including those caused by a person who starts a fight), injuries suffered while a worker was committing a serious crime injuries suffered while an employee was not on the job, and injuries suffered when an employee's conduct violated company policy. If your employer's conduct is especially egregious (for example, your employer did something intentional or reckless that injured you), you may be allowed to bypass the workers' compensation system and sue your employer in court-for much larger amounts of money than you could collect through workers' compensation. Wage benefits are calculated based upon the average weekly wage -- the wages of the employee over a period of time are totaled up and then averaged. Once that average has been calculated, the employee is typically entitled to two-thirds of that average weekly wage (up to a statutory ceiling). The second form of benefit received under workers' compensa­tion is medical coverage. If an employee is injured on the job, he or she is entitled to reasonable and necessary hospital and medi­cal treatment related to that injury to hopefully get him or her back on his or her and able to resume his or her employment. If the employee is not able to resume his or her former employ­ment, then he or she may be entitled to rehabilitation services that will either allow him or her to return to some other form of employment or be trained in a new line of work. A final type of compensation that the employee may be entitled to as a result of an on-the-job injury is compensation for permanent disability. Most workers' compensation acts have cre­ated a schedule in which specific disabilities are worth a certain number of weeks of wages. For instance, a person who loses a foot may be entitled to one hundred and fifty weeks of wages over and above any other benefits that he or she may receive. A person who loses an eye on the job may be entitled to an equivalent amount of compensation. Those forms of compensation are in addition to the wage loss benefits otherwise paid and any medi­cal expenses that have been paid. Your injury does not need to be caused by an accident-such as a fall from a ladder-to be covered. Many workers, for example, receive compensation for repetitive stress injuries, including carpal tunnel syndrome and back problems, that are caused by overuse or misuse over a long period of time. You may also be compensated for some illnesses and diseases that are the gradual result of work conditions-for example, heart conditions, lung disease, and stress-related digestive problems. As long as your injury is job-related, it's covered. For example, you'll be covered if you are injured while traveling on business, doing a work-related errand, or even attending a required, business-related social function.

Question 3

Can my workers' compensation benefits be capped?

Accepted Answer

There has been a good deal of controversy over the extent to which workers' compensation laws should provide benefits to injured employees. Many states put a cap on the amount of wage benefits that the employee can receive. In some jurisdictions the employee can receive no more than five hundred weeks of wage benefits, which is the equivalent of approximately ten years of benefits. This is to the advantage of the employer in that it puts a limitation on the employer's or the insurer's liability. However, it may be a detriment to the employee if the employee is permanently disabled and cannot return to any form of work. If in fact the employee is permanently and totally dis­abled, then he or she may be able to extend those benefits under state law. However, proving that a worker is both permanently and totally disabled is not an easy task. As such, in many states employees are left in a situation in which they cannot return to their former employment, yet at the end of the allowable time their wage benefits are terminated.

Question 4

What is the result of death or major medical treatment from a workers' compensation claim?

Accepted Answer

Death benefits and major medical treatments need to be dealt with carefully to make sure that the amount of money that the family receives as a result of the death or major medical treatment is maximized. Death Benefits In the event that an employee is killed on the job, the family of that employee is entitled to death benefits. Those death benefits are wage benefits that will, at least in part, replace the loss of income as a result of death of the employee. Medical Treatment There also is a good bit of controversy regarding the provision of medical treatment to injured workers. Typically, the medical treatment is controlled by the employer or the employer's insur­ance carrier. This means that the employee receives treatment from doctors who have been chosen by the insurance carrier or the employer. These doctors obviously know who is paying their bill and they know that the insurance carrier and the employer expect this employee to return to work at some point in time so that their financial exposure in paying wage benefits is limited. Although these doctors generally provide quality medical care for the injured employee, they have a somewhat mixed loyalty. They know that the employer and the insurance company want this employee to return to work, but they also know that it is not necessarily always in the employee's interest to return to work too quickly or even to return to that form of work at all. Complex Injuries The law relating to workers' compensation coverage can become extremely complex when dealing with issues of occupational disease. The run-of-the-mill, on-the-job injury in which an employee falls and breaks an ankle does not involve a great deal of controversy. However, the claim of the employee who over a period of time develops, for example, carpal tunnel syndrome as a result of typing at the keyboard, is harder to classify as being a result of the employment. Different states have dealt with that issue in a variety of ways. Some states provide coverage for these types of repetitive stress injuries or exposure injuries; other states do not. Another area of significant controversy in regard to workers' compensation claims is compensation for emotional injuries. In some states, an employee who suffers, for example, a nervous breakdown because of emotional stress on the job may be entitled to the whole range of benefits under the workers' compensation system. Other states have denied those types of benefits on the theory that the relationship between employment and emotional injury is simply too tenuous and therefore the employer should not be made to bear the burden of the expense associated with that type of injury.

Question 5

What if another employee or a third-party are to blame for injuries in a workers' compensation setting?

Accepted Answer

If an employee is injured on the job as a result of the fault of some third person, then that employee may have a basis for a claim (sometimes referred to as a third-party claim) against that other individual or company. For instance, suppose you are working on a construction job and you are employed by the gen­eral contractor. If, while performing those duties, an employee of a plumbing sub-contractor drops a pipe that strikes you on the head, you may be entitled to the benefits called for under the act. In addition to being compensated under the workers' compensation act, you may also have a basis for a claim against the plumbing sub-contractor whose employee dropped the pipe on you. In some states, on a construction job such as this, all contractors may be immune from suit by any other employee on that construction job. In other states, the employee may sue any other responsible contractor on the job. If the injured employee in that circumstance does recover money from the third party who caused the injury, then the employer of that injured worker (or more likely the employer's insurance carrier) is entitled to recover all or part of the monies paid to the worker under the workers' compensation act. This is a principle known as subrogation. Subrogation literally means that one party is subrogated or steps into the shoes of another party and acquires their rights. Under most workers' compensation acts, once the employee makes a claim for and receives benefits, then to the extent that the employee has any right of recovery against a third party, the employer or its insurance carrier acquires that right of recovery to the extent of wage and income benefits it paid to the employee. The purpose of allowing subrogation in this instance is to hold down the cost of workers' compensation insurance coverage and further to prevent the employee from receiving a double recovery on the wages and medical benefits received. If the employee receives compensation under the workers' compensation act and is further compensated for the same inju­ries as a result of the third-party civil claim, that constitutes a double recovery to the employee. After paying back amounts paid to him for wage and medical benefits under the workers' compen­sation act, the employee is entitled to keep any excess damages awarded by a jury or received in settlement.

Question 6

What is the purpose of workers' compensation law?

Accepted Answer

Workers' compensation is a form of insurance coverage that is designed to protect the working person in the event of injury. In a workers' compensation claim the parties involved are the injured worker, his or her employer, and the employer's workers' compensation insurance company. Before the passage of work­ers' compensation laws, a worker who was injured on the job was forced to file suit against his or her employer and potentially wait for months or even years before ever receiving any compensation for an injury. As a result, the worker and his or her family may have had no income for an extended period of time because the worker was injured and unable to work. Further, the worker often was unable to pay for medical treatment. If the worker did eventually recover from the employer in a civil action, that award of money damages frequently came too late for the worker since by that point he or she was destitute and perhaps permanently impaired because of the lack of proper medical treatment. As such, many states began passing workers' compensation laws that provided a type of compromise. Under these laws, the worker did not have to prove any fault on the part of the employer when injured, but simply had to prove that he or she was on the job and that the injury arose out of his or her employment. If those two things could be proven, then the worker was entitled to receive a portion of his or her wages for the period of time dis­abled and further was entitled to appropriate medical treatment related to that injury. In return for that, the employer received immunity from a civil claim brought by the employee for the injury. That is. the employee could not file a civil action against the employer. The employee's exclusive remedy is the worker's compensation benefits. Every state has its own workers' compensation law and that law can vary dramatically from state to state. The general thrust, however, of the worker's compensation system nationwide is as stated. In addition, there are workers' compensation acts that operate at the federal level. Individuals employed by the federal government are covered by the Federal Employees Compensation Act. It is a workers' compensation act that is admin­istered by the U.S. Department of Labor. There is also another federal statute known as the Longshoremen and Harbor Worker's Act, which technically covers longshoreman and harbor workers but includes private, non-federal employees who are working on defense installations as well. It also covers private employees working overseas who are covered by the Defense Base Act -- a type of workers' compensation act that incorporates the Longshoremen and Harbor Workers Act.

Workers Compensation Law

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